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HomeMy WebLinkAboutCox Neck Rd & CR 48 Traffic Control DeviceTown of Southold - Letter Board Me~f January 30, 2007 RESOLUTION 2007-144 ADOPTED Item # 16 DOC ID: 2568 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2007-144 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JANUARY 30, 2007: RESOLVED that the Town Board of the Town of Southold hereby authorizes and directs Supervisor Scott A. Russell to execute the Traffic Signal Agreements between the Coun~ of Suffolk and the Town of Southold for the installation and maintenance of traffic signals at CR 48, Middle Road ~ Cox Neck Road/Sound Avenue, Mattimek, subject to the approval of the Town Attomey. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Louisa P. Evans, Justice SECONDER: Thomas H. Wickham, Councilman AYES: Evans, Wickham, Ross, Edwards, Russell, Krupski Jr. Generated February 2, 2007 Page 23 Town of Southold with COS Law Dept. No. ~) 7~Y~.-~ ~f..~"~ Agreement Location: CR 48, Middle Rd. ~ Cox Neck Rd / Sound Ave.., Hamlet of Mattituck On"DriveS / D, ate:~ AGREEMENT FOR THE INSTALLATION OF TRAFFIC CONTROL DEVICES As Revised 8/03/05 FILE This AGREEMENT is between the County of Suffolk ("COUNTY"), a municipal corporation of the State of New York, having its principal office at the County Center, Riverhead, New York 11901, acting through its duly constituted Department of Public Works ("the DEPARTMENT") located at 335 Yaphank Avenue, Yaphank, New York 11980-9744, and the Town of SOUTHOLD ("TOWN"), having its principal office at Independence Hill, Farmingville, NY, 11738. TERMS AND CONDITIONS: Shall be as set forth in "Exhibit A" and "Exhibit B" attached hereto and made a part hereof. 1N WITNESS WHEREOF, the parties hereto have executed this Agreement as of the latest date written below: TOWN OF SOUTHOLD By: S cO"~I~ RUSSELL Supervisor I l~ate" APPROVED: By: . ~,.[~.~T ANDERSON, P.E. Date Chief Deputy Commissioner APPROVED AS TO LEGALITY: CHRISTINE MALAFI Suffolk County Attorney B/,a~IA~_~ BRADtDISH, ESQ. . Date Assistant Codnty Attorney COUNTY OF SUFFOLK By: PAUL SABATINO II ~ ~[/.,~l~*'[ Chief Deputy County Executive Date Town of Southold with COS Aereement Location: CR 48, Middle Rd. ~ Cox Neck Rd / Sound Ave.., Hamlet of Mattituck Law Dept. No. As Revised 8/03/05 EXHIBIT A WHEREAS, the DEPARTMENT operates a program to improve traffic signals, markings, signs and the like ("Devices") in order to ensure the safe and continuous movement of traffic, and WHEREAS, the DEPARTMENT has determined that certain Devices are necessary at the intersection of CR 48, Middle Road ~ Cox Neck Road / Sound Avenue, Hamlet of Mattituek for the improvement of traffic conditions at the said location within the TOWN, and the TOWN accepts said determination, and WHEREAS, pursuant to Section 136 of the New York State Highway Law, the Commissioner of the Suffolk County Department of Public Works ("Commissioner") is empowered to erect Devices, as authorized by the County Legislature, ia order to improve traffic conditions, and WHEREAS, the parties hereto desire to provide for the installation and maintenance of Devices at the aforesaid location within the TOWN for the improvement of traffic conditions, in accordance with a traffic signal plan on file with the DEPARTMENT: NOW, THEREFORE, in consideration of the individual and mutual covenants, promises and representations herein contained, the parties hereto agree as follows: 1. Definitions: meaning: The following terms whenever used in this Agreement shall have the following Devices: Traffic signals and associated appurtenances. Traffic Signal Service Report: A report of any and all work performed on the Devices. 2. Design~ Installation: The COUNTY shall install, at the expense of the Permit Applicant or through the COUNTY'S Capital or Operating Budget, Devices of the type, and at the location, set forth above. 3. Ownership: A. Any and all Devices installed pursuant to this Agreement shall be the sole and exclusive property of the TOWN. B. Any Devices removed from the site(s) designated herein shall be delivered to either the DEPARTMENT or the TOWN, as directed by the Conunissioner. 4. Operation and Maintenance: All costs incurred in the operation and maintenance of the Devices, including any and all charges for electricity, shall be borne by the TOWN or, in the case of a Permit Signal, the Permit Applicant, until such time as responsibility for the operation and maintenance of the Devices is assumed by the TOWN. At such time as responsibility for the operation and maintenance of the Devices is assumed by the TOWN, the TOWN shall operate and maintain the Devices in accordance with the current Maintenance Specifications of the DEPARTMENT. A copy of said specifications is available upon request at the DEPARTMENT. Page 1 Town of Southold with COS Law Dept. No. Agreement Location: CR 48, Middle Rd. ~ Cox Neck Rd / Sound Ave.., Hamlet of Mattituck As Revised 8/03/05 Co In the event that the TOWN has a set of Maintenance Specifications equivalent to that of the DEPARTMENT, the TOWN may, subject to the review and approval of same by the DE- PARTMENT, use same in lieu of the DEPARTMENT'S Maintenance Specifications. In connection with its maintenance of the Devices, the TOWN shall provide the COUNTY with a Traffic Signal Service Report whenever and wherever a maintenance problem exists which prevents the device from operating as designed. The TOWN shall keep all local police authorities aware of the party responsible for maintenance of the Devices. The TOWN shall establish procedures that will allow maintenance contractors and/or TOWN employees to provide maintenance services for the Devices on a 24-hour basis. 5. Modification of Devices: The TOWN shall not alter the signal operation or timing of the Devices without the prior written approval of the DEPARTMENT. In the event of any alteration to the signal operation or timing of the Devices, the TOWN shall furnish the DEPARTMENT with one (1) set of wiring diagrams for ach alteration. 6. Representations and Warranties: A. The TOWN shall enact any ordinance, order, rule or regulation necessary for the installation and maintenance of the Devices. Bo The TOWN shall comply, and shall require its officers, directors, partners, trustees and other members of its governing body, as well as any personnel employed to render services under this Agreement, to comply, with all applicable rules, regulations and requirements of law, including Suffolk County local preference laws and other applicable Suffolk County local laws, and reso- lutions of the Suffolk County Legislature. The TOWN shall maintain full and complete books and records of any and all Traffic Signal Service Reports. Such books and records shall be retained for a period of seven (7) years and shall be available for inspection by the DEPARTMENT, or its duly designated representative, upon written notice during regular business hours. D. The COUNTY agrees to transfer any and all warranties and representations on all equipment and materials installed by the COUNTY or its permittees to the TOWN. 7. Violation A. In the event that the TOWN fails to maintain the Devices in accordance with the terms of this Agreement, the COUNTY, in addition to any other remedies to which it may be entitled, may withhold funds for traffic improvements within the TOWN. B. The COUNTY shall provide the TOWN with written notice of the TOWN'S failure to maintain the Devices. Such notice shall specify the particular failure. The TOWN shall be given a reasonable period of time to correct any said failure. Page 2 Town of Southold with COS Law Dept. No. Aereernent Location: CR 48, Middle Rd. ~ Cox Neck Rd / Sound Ave.., Hamlet of Mattituck As Revised 8/03/05 8. Insurance (See Exhibit B) A. The TOWN shall procure, pay the entire premium for, and maintain throughout the term of this Agreement, insurance in amounts and types specified by the COUNTY. The TOWN agrees to require all of its subcontractors in connection with work performed for the TOWN related to this Agreement, procure, pay the entire premium for and maintain throughout the term of this Agreement, insurance in amounts and types equal to that specified by the COLrNTY for the TOWN. Unless otherwise specified by the COUNTY and agreed to by the TOWN, in writing, such insurance shall be as follows: i. COMMERCIAL GENERAL LIABILITY INSURANCE, including contractual coverage, in an amount not less than TWO MILLION AND NO/100THS ($2,000,000.00) DOLLARS per occurrence for bodily injury and TWO MILLION AND NO/100THS ($2,000,000.00) DOLLARS per occurrence for property damage. ii. AUTOMOBILE LIABILITY INSURANCE, (if any vehicles are used by the TOWN in the performance of this Agreement including owned, non-owned, and hired cars) in an amount not less than Five Hundred Thousand Dollars ($500,000) per person, per accident, for bodily injury and not less than One Hundred Thousand Dollars ($100,000) for property damage per occurrence. iii. WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY INSURANCE, in compliance with all applicable New York State laws and regulations and DISABILITY BENEFITS INSURANCE, if required by law. The TOWN shall furnish to the COUNTY, prior to its execution of the Agreement, the documentation required by the State of New York Workers' Compensation Board of coverage or exemption from coverage pursuant to §§57 and 220 of the Workers' Compensation Law. In accordance with General Municipal Law § 108, this Agreement shall be void and of no effect unless the TOWN shall provide and maintain coverage during the term of this Agreement for the benefit of such employees as are required to be covered by the provisions of the Workers' Compensation Law. iv. PROFESSIONAL LIABILITY INSURANCE (ERRORS AND OMISSIONS), that covers any damage arising out of the TOWN'S performance of professional services caused by an error, omission, or negligent acts, in an amount not less than Two Million Dollars ($2,000,000) on either a per occurrence or claims made coverage basis. v. In the event the TOWN maintains a COMPREHENSIVE GENERAL LIABILITY INSURANCE policy form in lieu of Commercial General Liability, said policy must include all of the above requirements plus premises/operations, independent contractors, contractual, and broad form property damage. All policies providing such coverage shall be issued by insurance companies with an A.M. best rating orA- or better. All insurance shall be obtained from companies licensed to do business in the State of New York. Town of Southold with COS A~reement Location: CR 48, Middle Rd. @ Cox Neck Rd / Sound Ave.., Hamlet of Mattituck Law Dept. No. As Revised 8/03/05 Page 3 The County of Suffolk must be named Additional Insured and the TOWN shall furnish to the COUNTY a declaration page for each such policy of insurance, and upon request, a tree and certified original copy of each such policy, evidencing compliance with the aforesaid insurance requirements. In the case of commercial general liability insurance, the County of Suffolk shall be named as an additional insured and the TOWN shall furnish a Declaration page and endorsement page evidencing the County's status as an additional insured on said policy. Where work under this Agreement is sub-contracted, the TOWN must require the subcontractor to provide that the COUNTY be named as an additional insured on all required policies, as well as require the subcontractor to provide the COUNTY with all required evidence of insurance. All such Declaration Pages, certificates and other evidence of insurance shall provide for the County of Suffolk to be notified in writing thirty (30) days prior to any cancellation, non-renewal or material change in said policies. Required limits of insurance are not to be modified by deductibles that the COUNTY deems excessive without the COUNTY'S written permission. All such Declaration Pages, certificates, policies and other evidence of insurance and notices shall be mailed to the DEPARTMENT and to the Suffolk County Risk Management and Benefit Division [700 Veterans Memorial Highway, 2nd Floor, Hanppauge, New York 11788, or such other address of which the COUNTY shall have given the TOWN written notice]. If the TOWN, as a municipal corporation, has a self insurance program under which it acts as a self insurer for any of such for any such required coverage, it may provide self-funded coverage, declarations and certificates or other evidence of such self-insurance in lieu of insurance issued by insurance companies. In the event the TOWN fails to provide the Declaration Pages or certificates of insurance or to maintain any insurance required by this Agreement, the COUNTY may, but shall not be required to, obtain such policies and deduct the cost thereof from payments due the TOWN under this Agreement or any other Agreement between the COUNTY and the TOWN. The COUNTY will not authorize work to begin under this Agreement until aH the required insurance has been obtained and said insurance has been approved and filed by the COUNTY. Approval of the insurance by the County shaH not relieve or decrease the liability of the TOWN. The TOWN shall assume all responsibility for the insurance requirements of any applicable sub-consultants. 9. Indemnification: To the greatest extent permitted by law, the TOWN agrees that it shall protect, indcnmify and hold harmless the County and its officers, officials, employees, contractors, agents and other persons (the "County Indenmified Parties") from and against all liabilities, fmcs, penalties, actions, damages, claims, demands, judgments, losses, costs, expenses, suits or actions and reasonable attorneys' fees, arising out of thc acts or omissions or the negligence of the Contractor in connections with thc services described or referred to in this Agreement. The TOWN shall defend the County in any suit, including appeals, or at the County's option, pay reasonable attorney's fees for defense of any such suit arising out of the acts or omissions or negligence of the TOWN, its officers, officials, employees, subcontractors or agents, is any, in connection with the services described or referred to in this Agreement. Town of Southold with COS A~reement Location: CR 48, Middle Rd. ~ Cox Neck Rd / Sound Ave.., Hamlet of Mattimck Law Dept. No. As Revised 8/03/05 Page 4 10. Licenses: The TOWN covenants, warrants and represents that it has, and shall have throughout the term of this Agreement, and that, to the extent applicable, its employees, agents and subcontractors have, and shall have throughout the term of this Agreement, the required education, knowledge, experience and character necessary to qualify them individually for the particular duties they are to perform with respect to this Agreement (the "Services"), and that the TOWN has, and shall have, and, to the extent applicable, its employees, agents and subcontractors have, and shall have throughout the term of this Agreement, all required authorization(s), registration(s), license(s) or permit(s) [hereinafter collectively referred to as a "License"] required by State, COUNTY or local authorities for the Services. The TOWN shall forward to the DEPARTMENT a copy of its License or, if applicable, a complete list of its employees, agents and subcontractors providing Services, including names, area of License, License numbers and copies of License(s). The TOWN shall furnish the DEPARTMENT with copies of any updates, additions or deletions to such list as the same may occur, together with copies of any new or renewal License(s). The TOWN shall immediately notify the DEPARTMENT, in writing, of any disciplinary proceedings against the holder of any License. In the event that the TOWN or such other holder of a License is no longer licensed for any one or mom of the Services, the TOWN shall immediately so notify the DEPARTMENT. 11. Offset of Arrears or Default: The TOWN warrants that it is not, and shall not be during the term of this Agreement, in arrears to thc COUNTY for taxes or upon debt or contract and that it is not, and shall not be during the term of this Agreement, in default as surety, contractor or otherwise on any obligation to the COUNTY. The COUNTY may withhold the mount of any such arrearage or default from amounts payable to the TOWN under this Agreement. 12. Termination: In the event that the COUNTY assumes responsibility for the maintenance of the Devices, this Agreement shall automatically be deemed terminated. 13. Merger; Modification: This Agreement represents the entire agreement of the parties. All previous understandings of the parties concerning the terms hereof are merged into this Agreement. No modification of this Agreement shall be valid unless written and executed by both parties. 14. Local Law No. 32-1980: TOWN warrants and represents that TOWN has not offered or given any gratuity to any official, employee or agent of Suffolk County, New York State or any political party with the purpose or intent of securing an agreement or securing favorable treatment with respect to the awarding or amending of an agreement, or the making of any determinations with respect to the performance of an agreement, and that TOWN has read and is familiar with the provisions of Suffolk County Local Law Number 32- 1980 (Chapter 386 of the Suffolk County Code). 15. Liviw, Waee Law: This Agreement is subject to the Living Wage Law of the County of Suffolk. The law requires that, unless specific exemptions apply, or a waiver is granted, all employers (as defined) under service contracts and recipients of county financial assistance (as defined) shall provide payment of a minimum wage to employees as set forth in the Living Wage Law. Such rote shall be adjusted annually pursuant to the terms of the Suffolk County Living Wage Law of the County of Suffolk. Under the provisions of the Living Wage Law, the COUNTY shall have the authority, under appropriate circumstances, to terminate this Agreement and to seek other remedies as set forth therein, for violations of this law. 16. Child Sexual Abuse Reporting Policy: The TOWN agrees to comply with Chapter 577, Axficle IV of the Suffolk County Code, entitled, "Child Sexual Abuse Reporting Policy", as now in effect or amended hereat~er or of any other Suffolk County Local Law that may become applicable during the term of this Agreement with regard to child sexual abuse reporting policy. Page 5 Town of Southold with COS A~reernent Location: CR 48, Middle Rd. ~ Cox Neck Rd / Sound Ave.., Haml~ of Mattituck Law Dept. No. As Revised 8/03/05 17. Public Disclosure Statement: The TOWN represents and warrants that the TOWN has filed with the Comptroller of Suffolk County the verified public disclosure statement required by Suffolk County Administrative Code Section A5-7 and shall file an update of such statement with the said Comptroller on or before the 31 st day of January in each year of this Agreement's duration. The TOWN acknowledges that such filing is a material, contractual and statutory duty and that the failure to file such statement shall constitute a material breach of this Agreement, for which the County shall be entitled, upon a determination that such breach has occurred, to damages, in addition to all other legal remedies, of fittecn percent (15%) of the amount of the Agreement. 18. Certification: The parties to this Agreement hereby certify that, other than the funds provided in this Agreement and other valid Agreements with the County, there is no known relationship within the third degree of consanguinity, life partner, or business, commercial, economic, or financial relationship between the parties, the signatories to this Agreement, and any partners, members, directors, or shareholders of five percent (5%) (or more) of any party to this Agreement. 19. Set-Off Rights: The County shall have all of its common law, equitable, and statutory rights of set- off. These rights shall include, but not be limited to, the County's option to withhold, for the purposes of set-off, any moneys due to the Contractor under this contract up to any amounts due and owing to the County with regard to this contract and/or any other contract with any County department or agency, including any contract for a term commencing prior to the term of this contract, plus any amounts due and owing to the County for any other reason including, without limitation, tax delinquencies, fee delinquencies or monetary penalties relative thereto. The County shall exercise its set-off rights in accordance with normal County practices including, in cases of set-offpursuant to an audit, the finalization of such audit by the County agency, its representatives, or the County Comptroller, and only after legal consultation with the County Attorney. 20. Use of County Resources to Interfere with Collective Bargaining Activities Local Law No. 26-2003: The Contractor represents and warrants that it has read and is familiar with the requirements of Article 1, Chapter 466 of the Suffolk County Local Laws, "Use of County Resources to Interfere with Collective Bargaining Activities". County Contractors (as defined) shall comply with all requirements of Local Law No. 26-2003 including the following prohibitions: a. The Contractor shall not use County funds to assist, promote, or deter union organizing. b. No County funds shall be used to reimburse the Contractor for any costs incurred to assist, promote, or deter union organizing. c. The County of Suffolk shall not use County funds to assist, promote, or deter union organizing. d. No employer shall use County prope~y to hold a meeting with employees or supervisors if the purpose of such meeting is to assist, promote, or deter union organizing. If Contractor services are performed on County property the Contractor must adopt a reasonable access agreement, a neutrality agreement, fair communication agreement, non-intimidation agreement and a majority authorization card agreement. If Contractor services are for the provision of human services and such services are not to be performed on County property, the Contractor must adopt, at the least, a neutrality agreement. Under the provisions of Local Law No. 26-2003, the County shall have the authority, under appropriate circumstances, to terminate this Agreement and to seek other remedies as set forth therein, for violations of this Law. Page 6 End of Text · CERTIFICATE OF LIABILITY INSURANCE ~ 02/0712007 PRODUCER ~ (~1 ~7~ F~ ROY H REdE AGENCY, ]NC. ~lS CE~FI~TE 18 ISLED ~ A ~R OF ~FOR~ON PO BOX ~ ONLY AND CONF.8 NO ~GH~ UPON ~ HO~ER, ~ ~T~I~ DO~ NOT ~END, EX.ND MA~ITUCK ~ t~g52 ~R ~E CO~GE AFFORDED ~ ~E POLICIES B~, INSURERS ~FORDING CO~GE NAIC INSURED I ~e~n u~ ce O. ~932 TO~ O~ ~OU~OLD iN~U~ER B: Amerlcam Airwave In~u~ ~om~ C/O ~OUTHOLD TO~ HALL P.O. BOX ~17g ~SURER C: SOUTHOLD NY 11911 iNSURER D: ,, ,,, INSURER E: o=~;~t, ,_~,~,~r CPEL-IO01.0? 01/01/07 01/01/08 EA~;H O~C)URREN(~E %000,000 X CO~CTUAL LtASILI~'Y GENERAl. AGGREGATE .~ Ltl'OMO BILE LIABII.ITy CPEL-1001-07 01/01~7 01/01/08 COMBINED EINGLE LIMIT X ,Vet' xl.rro (~.~ ~,~m} ,I; 1,000,000 A r--- ^,,,,~UTO'~__ OTHER 'r,~., $ Am'o ON~Y; .~.c).e... $.. EXC)ESSx I /UMBRELLAF_..lUAmU~Y 60A2UD000057703 01/01/07 0t/01/09 ~.ACH O¢OUI~P<~¢O; ,-- ~..,,~ .. 1,_.0~000 0.~_ B $ X RC~NTION s t0,000 DE$CR PTION OF uI"-t~,TIOHSILOCATIONSNEHICLES/EXDLU$1ON8 ADDED BY ENDORSEMENT/SPECIAL PROVIEIONS CERTIFICATE HOLDER IS LISTED A~ ADDITIONAL INSURED WITH RESPECT TO GENERAL LIABILITY, REGARDING THE TRAFFIC SIGNAL AGREEMENT ~ CR ~8, MIDDLE ROAD AND COX NECK ROAD/SOUND AVENUE, MATTITUCK. NY 11992, EXHIBIT B (Insurance.#8} CATE HOLDER CANCELLATION SUFFOLK COUNTY' DEPT. OF PUBLIC WORKS 'i'D) DO 80 SHALL IMF08E NO OI~LJOATION OR [.lABILITY OF RNY KiND UPON THE INSURER, 335 YAPHANK AVENUE ITs AGENTS OR REPRESENTATIVES. YAPHANK, NY 11980 AUTHORBED REPRESENTATNE Attention: ~~c~ ACORD 25 (2001108) Certificate # 9218 © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed, A statement on this certificate doss not confer rights to the certificate holder in lieu of such endorsement(s), If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the ce~ficate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of thfs form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ,~CORD 25-S (2001/08) Certificate SUFFOLK COUNTY DEPARTMENT OF LABOR- LIVING WAGE UNIT NOTICE OF NON-APPLICABILITY OF LIVING WAGE LAW Living Wage Law, Suffolk County Code, Chapter 347 (2001) To Be Completed By The Living Wage Unit DATE: TO: FROM:. ~Brenda Rosenberg, Director TELEPItONE #: 853-5630 EMPLOYER: Town of Southold {traffic si~naB VENDOR #: 11-6001939 February 15~ 2007 Robert J. Bornholdt, Dir. of Traffic Safety, SCDPW (Awarding Agency) (Living Wage Unit) REF: CR 48 Middle Road ~ Cox Neck Rd/Sound Ave. Hamlet of Mattituck You are hereby notified that the response t~om Town of Southold (traffic signal) has been evaluated by the Living Wage Unit of the Suffolk County Department of Labor. We find that this employer is not covered by the Suffolk County Living Wage Law (Local Law #12-2001), and that the requirements of this law as currently constituted do not constrain this contractor at this time. Brenda Rosenberg Director of Living Wage Compliance Suffolk County Department of Labor LW-26 Suffolk County Living Wage Requirements Exhibit As Last Revised by the Suffolk County Department of Labor on 9/26/02 Suffolk County Living Wage Requirements Exhibit As Last Revised by the Suffolk County Department of Labor on 9/26/02 Pursuant to Section 6 of Chapter 347 of the Suffolk County Local Law No. 12-2001, "A Local Law to Implement Living Wage Policy for the County of Suffolk" (the "Living Wage Law"), aH RFP's, County contracts and financial assistance agreements subject to the law shah contain the following two paragraphs or substantially equivalent language: This Agreement is subject to the Living Wage Law of the County of Suffolk. The law requires that, unless specific exemptions apply, or a waiver is granted, all employers (as defined) under service contracts and recipients of county financial assistance, (ns defined) shah provide payment of a minimum wage of employees (as defined) of $9.00 per hour with health benefits of at least $1.25 per or otherwise $10.25 per hours. Such rate shall be adjusted annually pursuant to the terms of the Suffolk County Living Wage Law, of the County of Suffolk. Under the provisions of the Living Wage Law, the County shah have the authority, under the appropriate circumstances, to terminate this Agreement and to seek other remedies as set forth therein, for violations of this law. Suffolk County Local Law No. -2002, "A Local Law to Implement Living Wage Policy for the County of Suffolk" provided for certain amendments to the Living Wage Law. Forms for Completion and/or Signature (as applicable) Suffolk County Department of Labor - Living Wage Unit Notice of Application for County Assistance (Contract) Form LW-1 (consists of 1 page) Suffolk County Department of Labor - Living Wage Unit Certification of Compliance Form LW-2 (consists of 1 page) Suffolk County Department of Labor - Living Wage Unit Certificate of the Non-Applicability of the Living Wage Law Form LW-3 (consists of 2 pages) Suffolk County Department of Labor - Living Wage Unit Request for General Living Wage Exemption Form LW-4 (consists of 1 page) Suffolk County Department of Labor - Living Wage Unit Request for Specific Living Wage Exemption Form LW-5 (consists of 2 pages) 1 of 2 pages Suffolk County Living Wage Requirements Exhibit As Last Revised by the Suffolk County Department of Labor on 9/26/02 Suffolk County Department of Labor - Living Wage Unit Declaration of Compliance - Subject to Audit Form LW-33 (consists of 1 page) Note: Pursuant to Section 7 of Local Law No. -2002, "A Local Law to Implement Living Wage Policy for County of Suffolk", all employers subject to the provisions of the Living Wage Law shall submit a completed and sworn (under +penalty of perjury) Certification of Compliance Subject to Audit form, signed by an authorized representative, as part of an executed contract with the County of Suffolk. The complete Declaration of Compliance form shall be made a part of any executed contract or project agreement and made available to the public upon request. · To certify Living Wage compliance: Return Form LW-1, Form LW-222 and Form LW-33. Or · To certify non-applicability of Living Wage law: Return Form LW-3. Or · To request and document a general living wage exemption: Return Form LW-, LW-2 and Form LW-4 Or · To request and document a specific living wage exemption: Return Form LW-1, LW-2 and Form LW-5. In the event that there is a change in circumstances, it is the Contractor's responsibility of submit to the County additional Living Wage forms which either replace or supplement prior submissions of Living Wage forms. Living Wage Law Information Fact Sheet, text of the Local Law, Frequently Asked Questions, Forms, and Rules and Regulations can be found on the Suffolk County web site at www.co.suffolk.ny.us Click Department Directory Labor Living Wage Law Info Suffolk County Department of Labor Living Wage Unit Tel. (631) 853-3808 End of Text for Suffolk County Living Wage Requirements Exhibit As Last Revised by thc Suffolk County Department of Labor on 9/26/02 2 of 2 pages SUFFOLK COUNTY DEPARTMENT OF LABOR - LIVING WAGE UNIT CERTIFICATION OF THE NON-APPLICABILITY OF THE LIVING WAGE LAW Living Wage Law, Suffolk County Code, Chapter 347 (2001) To Be Completed by Applicant (Employer) 1) EMPLOYER NAME: Town of Southold 2) ADDRESS: Sonthold Town Hall, PO Box 1179~ Southold, NY~ 11971 3) CONTACT: Supervisor Scott A. Russell 4) TELEPHONE #: 765-1889 5) PROJECT NAME: (IF DIFFERENT FROM #1) 6) ORIGIN OF ASSISTANCE SOUGHT: (E.G., State of County assistance program and contracting Department). 7) AMOUNT OF CONTRACT: 8: TERMS OF CONTRACT: N/A 9) BRIEF DESCRIPTION OF PROJECT OR SERVICE: Traffic Signal Agreement for: CR 48, Middle Road ~ Cox Neck Road / Sound Avenue, Hamlet of Mattituck 10) PROJECTED EMPLOYMENT NEEDS: (attach a statement of projected needs by job classification, under the prospective assistance, including calculation of estimated net increase or decrease in jobs as a result of assistance). Reason Living Wage Law is not applicable: No Money Involved I hereby attest that the provisions of Suffolk County Local Law No. 12-2001, the Suffolk County Living Wage Law, are not applicable to this agency, organization, employer, contract or assistance applied for. I declare under penalty of perjury under the Laws of the State of New York that the undersign, p~ is authorized to provide this certification, and that the above attestation is true and Sign~fture Date Print Name & Title Vendor # CR 48~ Middle Road ~ Cox Neck Road / Sound Avenue~ Handet of Mattituck I~' Suffolk County Form 22 Contractor's/Vendor's Public Disclosure Statement Pursuant to Section A5-7 of the Suffolk County Administrative Code, this Public Disclosure Statement must be completed by all contractors/vendors that have a contract with Suffolk County. In the event contractor/vendor is exempt from completing paragraphs numbered 1 through 11 below, so indicate at paragraph number 12 below setting forth the reason for such exemption. Notwithstanding such exempt status, you must execute this form below before a notary public. 1. Contractor's/Vendor's Name .'~ oo rl ~ ~C'~2> t.A:tL~ ~/d Address 5.b City and State Contracting Department's Name Address Zip Code Payee Identification or Social Security No. Type of Business__Corporation Partnership Sole Proprietorship Other Is contractor/vendor entering into or has contractor/vendor entered into a contract with Suffolk County in excess of $1,0007 Yes No. Has contractor/vendor entered into three or more contracts, including the one for which you are now completing this form, with Suffolk County, any three of which, when combined, exceed $1,0007 Yes No. Table of Organization. List names and addresses of all principals; that is, all individuals serving on the Board of Directors or comparable body, names and addresses of all partners, and names and addresses of all corporate officers. Conspicuously identify any person in this table of organization who is also an officer or an employee of Suffolk County. (Attach additional sheet if necessary.) List all names and addresses of those individual shareholders holding more than five percent (5%) interest in the contractor/vendor. Conspicuously identify any shareholder who is also an officer or an employee of Suffolk County. (Attach additional sheet if necessary). 10. Does contractor/vendor derive 50% or more of its total revenues from its contractual or vendor relationship with Suffolk County?..__Yes__No. If you answered yes to 8 above, you must submit with this disclosure statement, a complete financial statement listing all assets and liabilities as well as a profit and loss statement. These statements must be certified by a Certified Public Accountant. (Strike this out if not applicable.) The undersigned shall include this Contractor's/vendor's Public Disclosure Statement with the contract. (Describe general nature of the contract.) 11. Remedies. The failure to file a verified public disclosure statement as required under local law shall constitute a material breach of contract. Suffolk County may reso~, use or employ any remedies contained in Article II of the Uniform Commercial Code of the State of New York. In addition to all legal remedies, Suffolk County shall be entitled, upon a determination that a breach has occurred, to damages equal to fifteen percent (15%) of the amount of the contract. 12. If you are one of the entities listed below at a) through c) or you qualify under d) below, you are exempt from completing paragraphs numbered 1 through 11 herein: __ a) Hospital ~X _ b) Educational or governmental entities __ c) Not-for-profit corporations __ d) Contracts providing for foster care, family day-care providers or child protective services Please check to the left side of the appropriate exemption. 13. Dated: Printed Name of Signer: Title of Signer: Name of Contractor/Vendor: Verification. This section must be signed by an officer or principal of the contractor/vendor authorized to sign for the company for the purpose of executing contracts. The undersigned being sworn, affirms under the penalties of perjury;~/that he/she has read and understood the foregoing statements and that they are, to his/her owll'j~nowledge, true. UNIFORM CERTIFICATE OF ACKNOWLEDGMENT (Within New York State) STATE OF NEW YORK) COUNTY OF-Y~ss.: On the ~ day of ~ in the year 20 O ~ before me, the undersigned, personally appeared ~.~:~~nally known to me or proved to me on the basis of satisfactory evidence to be the individual(X) whose name00 is (ar~) subscribed to the within insmunent and acknowledged to me that he/she~ executed the same in his/har,~a~ capacity(.ies) and that by his~ signature00 on the instrument, the individual(}), or the person upon behalf of which the individual(S) acted, executed the insmanent. (sig~a-t~are'and ot~ce of ind~ividual taking acknowledgement) LINDA J COOPER NOTARY PUBLIC, State of New York NO. 01CO4822563, Suffolk Cou/n~ Term Expires December 31, 20/ .. UNIFORM CERTIFICATE OF ACKNOWLEDGEMENT (Without New York State) STATE OF ) )SS.** COUNTY OF ) On the day of in the year 20 before me, the undersigned, personally appeared personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies) and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument, and that such individual(s) made such appearance before the undersigned in (Insert the city or other political subdivision and the state or country or other place the acknowledgement was taken) (signature and office of individual taking acknowledgement)